Chapter 57- STIs and STDs

What are the main types of sexually transmitted infections (STIs)?

Bacterial infections, parasitic/protozoan infections, and viral infections.

Name three bacterial STIs.

Chlamydia, Gonorrhea, and Syphilis.

What are some viral STIs?

Genital herpes, HIV, Hepatitis B and C, HPV, and Molluscum.

What is the annual incidence of new STIs in the United States?

Nearly 26 million new infections occur each year.

What socioeconomic factors contribute to the increased risk of STIs?

Decreased condom use and cuts to STD programs.

How does having one STI affect the risk of getting another?

Having one STI increases the risk of getting another.

What is the incubation period for STIs?

The time from initial infection to when symptoms first appear or screening tests are positive.

What must be reported to public health authorities in the U.S. regarding STIs?

All cases of gonorrhea, syphilis, and chlamydia must be reported.

What are some high-risk behaviors that increase the incidence of STIs?

Alcohol or drug use, new or multiple sexual partners, and inconsistent condom use.

What is the most common STI in the United States?

Chlamydia, with approximately 1.6 million new cases per year.

What bacterium causes chlamydial infections?

Chlamydia trachomatis.

What are common symptoms of chlamydial infections in men?

Pain with urination (dysuria) and urethral discharge.

What are common symptoms of chlamydial infections in women?

Mucopurulent vaginal discharge, abnormal vaginal bleeding, and dysuria.

What complications can arise from untreated chlamydial infections in women?

Pelvic inflammatory disease (PID), ectopic pregnancy, and infertility.

What diagnostic test is commonly used for chlamydial infections?

Nucleic acid amplification testing (NAAT).

What is the recommended drug therapy for chlamydial infections?

Doxycycline twice a day for 7 days.

What is the second most common reportable STI?

Gonorrhea.

What bacterium causes gonococcal infections?

Neisseria gonorrhoeae.

What are common symptoms of gonorrhea in men?

Dysuria and purulent discharge.

What complications can arise from untreated gonorrhea?

Epididymitis in men and pelvic inflammatory disease (PID) in women.

What is the risk of gonococcal conjunctivitis in neonates?

It can result in permanent blindness if not treated.

What factors increase the risk of STIs in women?

Anatomy that increases risk, less likelihood of showing early signs, and more frequent complications.

What factors increase the risk of STIs in men?

Less likely to seek medical care unless symptomatic and easier to diagnose due to anatomy.

What is the incubation period for gonorrhea?

1 to 14 days.

What is the importance of treating sexual partners for STIs?

To avoid the 'ping-pong' effect of reinfection.

What is expedited partner therapy (EPT)?

Providing drugs or prescriptions to partners without an exam to prevent reinfection.

What has gonorrhoeae developed resistance to?

Many classes of antibiotics

What is the first-line treatment for gonorrhea?

High-dose IM ceftriaxone

What should be done for patients who persistently test positive for gonorrhea?

Do sensitivity testing

What patient education should be provided for gonorrhea?

Treat all sexual contacts within the last 60 days; abstain from sexual contact for 7 days; return for repeat testing in 3 months.

What organism causes trichomoniasis?

Trichomonas vaginalis

How common is trichomoniasis in the United States?

2.6 million cases

What is the incubation period for trichomoniasis?

1 week to 1 month or longer

What is the most common site of infection for men with trichomoniasis?

Urethra

What are common symptoms of trichomoniasis in women?

Painful urination, vaginal itching, painful intercourse, bleeding after sex, yellow-green discharge with a foul odor.

What is a common clinical manifestation of trichomoniasis?

Strawberry appearance of the cervix

What complications can arise from untreated trichomoniasis?

Increased likelihood of acquiring or transmitting another STI, particularly HIV.

What diagnostic tests are used for trichomoniasis?

NAAT testing, culture, point-of-care testing, direct visualization of trichomonads.

What is the treatment for trichomoniasis?

Metronidazole or tinidazole; abstain from sex for 7 days after treatment.

What is the most common sexually transmitted infection characterized by genital lesions?

Genital herpes infections

What are the two strains of herpes simplex virus?

HSV-1 and HSV-2

How is genital herpes transmitted?

Through mucous membranes or breaks in skin during contact with an infected person.

What is the incubation period for genital herpes?

2 to 12 days

What are the stages of a primary genital herpes episode?

Prodromal stage, vesicular stage, ulcerative stage, final stage.

What are common triggers for recurrent genital herpes episodes?

Stress, fatigue, sunburn, immunosuppression, menses.

What is a significant complication of genital herpes?

Transmission from mother to baby during birth.

What diagnostic studies are used for genital herpes?

History and physical exam, viral isolation by tissue culture, antibody assay.

What antiviral agents are used for treating genital herpes?

Acyclovir, famciclovir, valacyclovir.

What is the primary goal of treatment for genital warts?

Removal of symptomatic warts.

How is HPV primarily transmitted?

Skin-to-skin contact during vaginal, anal, or oral sex.

What are the common clinical manifestations of genital warts?

Single or multiple papillary growths, may coalesce to form large masses.

What are the complications associated with genital warts?

Psychosocial burden, cosmetic appearance, and potential for certain strains to cause cancer.

What is the recommended vaccine for HPV?

9-valent vaccine (Gardasil 9)

What is syphilis caused by?

Treponema pallidum (bacterial spirochete)

What is the average incubation period for syphilis?

21 days, but can range from 10 to 90 days.

What are the stages of syphilis?

Primary, secondary, tertiary (or late) syphilis.

What are the symptoms of primary syphilis?

Single or multiple chancres, regional lymphadenopathy.

What are the systemic symptoms of secondary syphilis?

Flu-like symptoms, mucous patches, rash on palms and/or soles.

What can occur during tertiary syphilis?

Organ damage, gummas, cardiovascular issues, and neurosyphilis.

What are the diagnostic studies for syphilis?

Blood tests for screening and staging infection.

What organism causes gonorrhea?

Neisseria gonorrhoeae

What protozoan parasite causes trichomoniasis?

Trichomonas vaginalis

What is a common diagnostic test for trichomoniasis?

NAAT testing of vaginal or endocervical secretions or urine.

What is the primary treatment for trichomoniasis?

Metronidazole (Flagyl) or tinidazole (Tindamax)

What is the main complication of untreated trichomoniasis?

Increased likelihood of acquiring or transmitting another STI, particularly HIV.

What virus causes genital herpes?

Herpes simplex virus (HSV-1 and HSV-2)

What is the primary mode of transmission for genital herpes?

Direct contact with an infected person.

What is a significant risk associated with genital herpes during pregnancy?

Transmission from mother to baby during birth, especially during a primary episode.

What is the recommended antiviral treatment for genital herpes?

Acyclovir (Zovirax), Famciclovir (Famvir), or Valacyclovir (Valtrex).

What virus is responsible for genital warts?

Human papillomavirus (HPV)

What is the incubation period for HPV leading to genital warts?

Weeks to months to years.

What are common clinical manifestations of genital warts?

Single or multiple papillary growths, may coalesce to form large, cauliflower-like masses.

What is the most common method for diagnosing genital warts?

Visual inspection of characteristic lesions.

What is the primary bacterial cause of syphilis?

Treponema pallidum

What is the incubation period for syphilis?

Averages 21 days but can range from 10 to 90 days.

What are common symptoms of primary syphilis?

Single or multiple chancres, regional lymphadenopathy.

What are systemic symptoms associated with secondary syphilis?

Flu-like symptoms, mucous patches, and a rash.

What is a significant complication of tertiary syphilis?

Organ damage, gummas, and neurosyphilis.

What diagnostic tests are used for syphilis?

Blood tests to detect antibodies to T. pallidum.

What is the recommended treatment for syphilis?

Penicillin G

What is the impact of untreated syphilis on HIV transmission?

Chancres enhance HIV transmission risk.

What is the recommended vaccination for HPV?

9-valent vaccine (Gardasil 9)

What is the recommended age for HPV vaccination?

11-12 years old, but can start at age 9 up to age 26.

What is the purpose of the pallidum particle agglutination test?

It is used to test for syphilis.

What does the EIA test for syphilis detect?

Qualitative enzyme-linked immunoassay for syphilis.

Why can't the EIA test be used to detect reinfection after treatment?

It remains positive even after treatment.

What do nontreponemal tests detect?

Antibodies not specific for syphilis.

What are the names of two nontreponemal tests?

VDRL and RPR tests.

When do nontreponemal tests typically become positive?

10 to 14 days after the appearance of a chancre.

What happens to the titer of a positive nontreponemal test during primary and secondary syphilis?

It continues to climb.

What can cause false-negative results in syphilis testing?

Testing during primary syphilis before antibodies are produced or if patients have other diseases.

What is recommended for HIV patients regarding syphilis testing?

Annual syphilis testing.

What is the first-line drug therapy for all stages of syphilis?

Penicillin G benzathine.

What should be done for all sexual contacts of a syphilis patient?

They should be treated if they were in contact within the preceding 90 days.

What is the main goal of interprofessional care for HIV?

To monitor disease progression and immune function.

What is the most common mode of HIV transmission?

Unprotected sexual contact with a person who has a high HIV viral load.

What does 'U=U' stand for in HIV transmission?

Undetectable equals untransmittable.

What is the target cell for HIV?

CD4+ T cell.

What happens to CD4+ T cell counts as HIV progresses?

They decline, leading to immune problems.

What are common symptoms of acute HIV infection?

Mononucleosis-like symptoms including fever, swollen lymph nodes, and sore throat.